Dysphagie als Hinweis auf ein Aneurysma der thorakalen Aorta: Diagnostik mit Verzögerung

Extrinsic oesophageal compression leading to dysphagia is a recognised but uncommon sole presentation of thoracic aortic aneurysms. This has been referred to as Dysphagia Aortica, and is a late presentation of large thoracic aneurysms, or a symptom of impending aorto-oesophageal fistula. We present the case of a 67 year old woman who presented repeatedly with dysphagia and weight loss over a 3 month period to specialists in three different disciplines. Eventually, a type II thoraco-abdominal aortic aneurysm causing extrinsic compression of the oesophagus was discovered. When dealing with patients who present with dysphagia, if no other cause is discovered, a thoracic aortic aneurysm should form part of the differential diagnosis, as this is potentially curable, and delays in diagnosis and treatment predispose to rupture and death.Dysphagie infolge äußerer Verengung des Ösophagus ist eine bekannte aber seltene Komplikation bei einem Aneurysma der thorakalen Aorta. Im weiteren Verlauf besteht die Gefahr einer drohenden Ruptur bzw. der aortoösophagealen Fistelbildung.Wir präsentieren den Fall einer 67-jährigen Frau mit Gewichtsverlust und Dysphagie über drei Monate, die mehrere Spezialisten konsultierte und bei der schließlich eine Ösophagusstenose infolge eines thorakoabdominellen Aortenaneurymas Typ II diagnostiziert wurde.Differenzialdiagnostisch sollte bei der Dysphagie, insbesondere wenn keine andere Ursache erhoben werden an, an ein thorakoabdominelles Aortenaneuryma gedacht werden, da diese Erkrankung potentiell korrigierbar ist und eine Verzögerung der Behandlung zur Ruptur führen kann

Thoracoscopic Excision of Mediastinal Parathyroid Adenomas: A Report of Two Cases

Two patients with primary hyperparathyroidism caused by solitary ectopic mediastinal parathyroid adenomas have been successfully treated by thoracoscopic excision. The patients were not suitable for open thoracic surgery. Both had right-sided adenomas confirmed by sestamibi and computerised tomography – one adjacent to the oesophagus at the level of D3, the other anterolateral to the ascending aorta. Both procedures were performed through one 12-mm camera port and two 5-mm operating ports, and were uncomplicated, with 30–45 minutes skin-to-skin operating time. Both patients were well enough to be discharged the next day, and both rapidly became normocalcaemic. At follow-up, neither had developed any complications. In selected cases, where an ectopic adenoma lies immediately deep to the mediastinal pleura, thoracoscopic excision offers considerable advantage over open thoracic surgery